HomeMy WebLinkAboutSWG2017-00312 - SWG As-Built - 12/1/2023 \
RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG + 1 --pu3 f-1— Assessor Parcel# 7-(119N- S' ( - k)00)
Applicant Name // c•-kv-ItS Subdivision (Name/Div/Block/Lot)
Applicant Address o2/0 04JI w47 Zr I Qpyteit ck'--
City, State, Zip PidiM 14 9 , cif Installer Name ,. - , , _
Site Address C' /icth wa'7zd &c,C11 Dr, Designer Name Ji,l 4✓t/e/`
. INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Onl ❑ Drainfield Only ❑Repair El Other
System Type Ni JV�6{-W v Pretreatment Type
>5 ft.from foundation? - - ❑ N/A YES 0 NO
>50 ft.from wells? - .- ❑ ® ❑
>50 ft.from surface water? - 0 El 0
Z
H Cleanout between building and tank? - - ❑ El ❑
U Tank baffles present? - - ❑ 0 ❑
I 24"access risers over each compartment?- - 0 El ❑
a.
W Effluent filter installed?- ❑ ❑ ❑
Septic tank size /V x ki 72'r ,�12' gal Manufacturer Tjilt/AWN' /�}s D aC�4/
3
Si D-box water level and speed levelers used? - - ❑ N/A ®YES ❑ NO
00 Manifold/D-box accessible from surface? - ❑ Iii.4 ❑
u.
°Z Check valves installed? - - 0 El 0
p Q I/
2 Transport Line Size 9,. Schedule/Class <ed1/0
Bedrooms installed (check one) ❑ 2 -3 ❑4 ❑ 5 ❑6 0 Commercial/Other
>10 ft.from foundation?- - ❑ N/A ❑ YES ❑ NO
>100 ft.from wells?- - 0liKI ❑
W >100 ft.from surface water? - - ❑ El ❑
Er >10 ft.from potable water lines?- - ❑ ® ❑
Z Q 5 CI ®> ft.from property lines and easements?- - ❑
re >30 ft.from downgradient curtain/foundation drains?- - ❑ ® ❑
o
Drainfield level and observation ports present - - 0
❑
❑ Graveless chambers or /RI Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ .® ❑
Pump tank setbacks consistent with septic tank? /N/A (� YES ID NO
Pump tank site l gal Manufacturer kl
t.7"){r •
Z
Q . 24"access riser(s)and accessible from surface?- - ❑ ® 0
dAlarm or Control Panel Installed? - - ❑ 0 Cl
2 Control Panel equipped with Timer!ETM/Counter- - ❑ ❑ 0
n
a. Pump installed in ❑ Bucket or X On Block or ElOther
O. �(}Pump Make/Model �-I I[?r { ✓02 [sQ Floats or 0 Transducer
Tank draw down ,,,it in/min Pump capacity VO qpm Squirt Height R
Pump on time t/r n Pump off time iiUs Daily flow set at 3e0 qpd
/,, ,,.y/vt updated 1277r2015
MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel#
RECORD DRAWING
❑ Drainfield&manifold
orientation&layout
w/dimensions for
re-location. t
❑ Trench/bed Q
dimensions andc ��'
within
ldayout
',, 3LL
within layout
❑ Septic/pump
placement
❑ Location of buildings
,'�I,,0T\
existing/proposed
❑ Observation ports, . vv
clean-out locations, �c..
&m
n V,)
clean a ifolds/d-boxes \
❑ Location of wells,
surface water,roads,
&waterlines. /
❑ Reserve area(s)
❑ North Arrow
If the designer or installer feel the need for additional information/comments,it may be attached.
Record drawing may also be on a seperate page attached. No.Pages Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
I certify that I installed the system in accordance with I certify that the system has been installed in accor-
the septic design stamped APPROVED"by Mason dance with the septic design stamped"APPROVED"by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
- 1
Signatureat-Installer Date
(‹,r�_- (CAA yttil
Printed Nahle of Signee
MASON COUNTY PUBLIC HEALTH ///���G*
The undersigned approves this installation Report and
Record Drawing on behalf of Mason County Public17-7
Health:
Signature of Fnvironrnental _.aith Specialist Data (designer's stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upde&ed/2m2°15
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